Element Details

7 min

Requirement Designation

Element Attributes

Code	Description
mandatory	The element must be used per the specification (e.g., XML schema validation). Note: The term mandatory applies to mandatory and required fields in the different standards.
business rule	If sent, the element must be used per the Surescripts business rule.
conditional	The element must be used per the conditions specified. Note: The term conditional applies to conditional and situational fields in the different standards.
recommended	Surescripts recommends sending the element as a best practice.

Note: This guide only includes data elements where Surescripts has specific requirements or further explains the field usage. Refer to the NCPDP RTPB XML Schema listed in Document References for a complete list of fields.

Message Header Elements

Element	Code	Comment
To/Primary	mandatory	Patient’s IIN. Can be provided for better patient prescription insurance matching. Populate with the patient's IIN found in the 271 Eligibility Response in the 2110C loop REF02. Recommend using value exactly as it was received in the 271 Eligibility Response. If patient’s IIN is not available, this should be the Surescripts ID, S00000000000005.
To/@Qualifier	mandatory	Value: IIN = IIN Number or PY = Payer/Processor
To/Secondary	conditional	Patient’s PCN. Can be provided for better patient prescription insurance matching. Populate with the patient's PCN found in the 271 Eligibility Response in the 2110C loop REF03. Recommend using value exactly as it was received in the 271 Eligibility Response.
To/@Qualifier	mandatory	Value: PCN = Processor Control Number
To/Tertiary	mandatory	PayerIdentification (Surescripts-assigned Participant ID of the PBM/payer). This can be found in the 271 Eligibility Response from the PBM/payer in loop 2100A NM109.
To/@Qualifier	mandatory	Value: PY = Payer/Processor
From/Primary	mandatory	The identification of the sender of the message. This is the Surescripts-assigned ParticipantID.
From/@Qualifier	mandatory	Value: D = Prescriber
MessageID	mandatory	A minimum set of standards/algorithms should be used when generating message IDs to ensure uniqueness. If possible, customers should utilize Global Unique Identifiers (GUIDs). Note: The MessageID in the RTPBResponse will be populated in the RelatesToMessageID field of the NewRx. See MessageID LinkageMessageID Linkage for more details. S.205: The sender shall ensure the combination of the From and MessageID elements, for all messages including Error, is unique for at least 18 months. Surescripts recommends an unformatted Globally Unique Identifier (GUID).
RelatesToMessageID	conditional	This element is case sensitive. RTPBRequest – Populate with value contained in the related Interchange Control Number ISA13 field from the 271 Eligibility Response. RTPBResponse – Populate with the MessageID from the RTPBRequest. See MessageID LinkageMessageID Linkage for more details. S.210: Customers shall support the scenarios in the Message Linkage section of this guide.
SentTime	mandatory	Date/time of initiation. Refer to UTC Time FormatUTC Time Format for information on how to properly format the date/time data.
SoftwareSender CertificationID	conditional	business rule SoftwareSenderCertificationID has a max length of 10 characters. Surescripts requires sending this field. Identifies the entity responsible for the software that generated the message. The developer may be a software vendor or, if the software was developed “in-house”, the developer is the entity sending the message (e.g., a chain). The value transmitted is determined by the Sender Software Developer.

MessageID Linkage

S.210: Customers shall support the scenarios in the Message Linkage section of this guide.

The table below illustrates how the MessageIDs in the Eligibility Response, RTPBRequest and RTPBResponse, and NewRx messages are linked.

Note: Populate the RelatesToMessageID in an Error message with the MessageID sent in the original message.

Field Names	Eligibility Response	RTPBRequest	RTPBResponse	NewRx
MessageID	ELIG43211	RTPBREQ1	RTPBRES1	NEWRX
	Assigned by responding PBM/payer. Note: This is the Interchange Control Number ISA13 field from the 271 Eligibility Response	Assigned by provider vendor	Assigned by PBM/payer	Assigned by provider vendor
RelatesTo MessageID	N/A	ELIG43211	RTPBREQ1	RTPBRES1
		If available, populate with the Interchange Control Number ISA13 field from the 271 Eligibility Response	Populate with the MessageID from RTPBRequest	If available, populate with the MessageID from RTPBResponse. Note: Only populate if ProcessedStatus = True

RTPBRequest Elements

Notes:

This guide only includes data elements where Surescripts has specific requirements or further explains the field usage. Refer to the Real-Time Prescription Benefit Standard v13 schema listed in Document References for a complete list of fields.

The RTPBRequest for a patient will be tied to the Eligibility Response received within the last 72 hours for that patient. This is accomplished by using the Interchange Control Number ISA13 from the 271 Eligibility Response in the RelatesToMessageID of the RTPBRequest.

Per ACR S.201, customers shall ensure all messages are syntactically correct before transmission to Surescripts.

Element	Code	Comment
Patient	mandatory
Name/LastName	mandatory	Patient last name. Populate with the Last Name found in the 271 Eligibility Response in the 2100C loop NM103. Recommend using value exactly as it was received in the 271 Eligibility Response.
Name/FirstName	mandatory	Patient first name. Populate with the First Name found in the 271 Eligibility Response in the 2100C loop NM104. Recommend using value exactly as it was received in the 271 Eligibility Response.
SexAndGender/ AdministrativeGender	mandatory	Patient gender. Populate with the patient's gender found in the 271 Eligibility Response in the 2100C loop DMG03. Recommend using value exactly as it was received in the 271 Eligibility Response.
DateOfBirth	mandatory	Date of birth of patient. Populate with the patient's date of birth found in the 271 Eligibility Response in the 2100C loop DMG02 that is qualified by the DMG01 code "D8". Recommend using value exactly as it was received in the 271 Eligibility Response.
StateProvince	mandatory	Patient’s state or province. Populate with the patient's state or province found in the 271 Eligibility Response in the 2100C loop N402. Recommend using value exactly as it was received in the 271 Eligibility Response.
PostalCode	mandatory	Patient’s address postal code. Populate with the patient's postal code found in the 271 Eligibility Response in the 2100C loop N403. Recommend using value exactly as it was received in the 271 Eligibility Response.
City Extension	mandatory	Patient’s city. Populate with the patient's city found in the 271 Eligibility Response in the 2100C loop N401. Recommend using value exactly as it was received in the 271 Eligibility Response. Customers should use the following URL: <Extension name="City" url="http://surescripts.com/extensions/RTPBRequest/Patient/City”>
BenefitsCoordination	mandatory
PBMMemberID	conditional	business rule Surescripts requires this field to be sent. Unique PBMMemberID for the Patient. The ID can be found in the 271 Eligibility Response from the PBM/payer in loop 2100C NM109.
RequestedProduct	mandatory
Product	mandatory
DrugCoded/NDC	mandatory	NDC of the requested medication. Note: If Surescripts identifies a more representative NDC, Surescripts may replace the NDC that was sent with the more representative NDC to ensure a successful RTPBResponse. NDC must be an 11-digit numeric in the 5-4-2 format. Dashes shall not be used and leading zeros shall not be suppressed. NDC should be representative. Do not send repackaged, obsolete, private label or unit dose NDC unless it is the only NDC available to identify the medication concept.
Quantity	mandatory
Value	mandatory	Quantity for the requested medication. To ensure successful message processing, DaysSupply and Quantity should be a numeric value and greater than zero (0).
CodeListQualifier	mandatory	Quantity CodeListQualifier for the requested medication. Value: 38 = Original Quantity
QuantityUnitOf Measure/Code	mandatory	The QuantityUnitCode should reflect the NCit code. If the NCit code is not sent, the provider vendor may not be able to translate the QuantityUnitCode and the response may result in an error. Example Value: C48542 = Tablet For a list of NCit codes, go to: http://evs.nci.nih.gov/ftp1/NCPDP/About.html. This list should be updated monthly. Use the NCPDP QuantityUnitOfMeasure Terminology rows from the downloaded data. PM.200: QuantityUnitOfMeasure Code Qualifiers shall be correctly associated with medication descriptions. Notes: Avoid using "Unspecified" for QuantityUnitOfMeasure in the request. If "Unspecified" is sent, the PBM may not be able to process and the response may result in an error. The quantity unit of measure code “C64933 (Each)” is only to be used for products that are not measured in volume or weight and can only be expressed in unity of one/each, such as canes, wheelchairs, various braces or orthotics and other DME supplies.
DaysSupply	mandatory	business rule DaysSupply must be sent for accurate pricing. DaysSupply is the estimated number of days the prescription will last excluding refills, based upon the prescribed quantity and directions. It is the prescribed quantity divided by the daily doses. While this is typically system calculated, the prescriber retains responsibility for the value. DaysSupply and Quantity must be a numeric value and greater than zero (0).
Diagnosis	conditional	ICD-10 diagnosis codes should be included on the RTPBRequest to improve PBM/payer processing accuracy.
Code	mandatory
@Qualifier	mandatory	Value: ABF = ICD10
Prescriber	mandatory
Identification/NPI	mandatory	NPI for the prescriber. NPI will be validated against the check digit routine. For specific information see: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/Downloads/NPIcheckdigit.pdf
Pharmacy	mandatory	business rule Pharmacy must be sent for accurate pricing.
Identification/NCPDPID	conditional	business rule The NCPDPID for the pharmacy must be sent in the RTPBRequest.
Identification/NPI	conditional	business rule The NPI (National Provider ID) for pharmacy must be sent in the RTPBRequest. NPI will be validated against the check digit routine. For specific information see: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/Downloads/NPIcheckdigit.pdf
BusinessName	mandatory	Store name.
PrimaryTelephoneNumber	mandatory	Store phone number.
SecondaryPharmacy Extension	conditional	business rule Secondary pharmacy must be an owned or contracted pharmacy affiliated with requesting organization. Customers should use the following URL: <Extension name="SecondaryPharmacy" url="http://surescripts.com/extensions/RTPBRequest/SecondaryPharmacy">
Identification/NCPDPID	conditional	business rule The NCPDPID for the secondary pharmacy must be sent in the RTPBRequest.
Identification/NPI	conditional	business rule The NPI (National Provider ID) for secondary pharmacy must be sent in the RTPBRequest. NPI will be validated against the check digit routine. For specific information see: https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/Downloads/NPIcheckdigit.pdf
BusinessName	mandatory	Store name.
PrimaryTelephoneNumber	mandatory	Store phone number.

RTPBResponse Elements

Notes:

This guide only includes data elements where Surescripts has specific requirements or further explains the field usage. Refer to the NCPDP RTPB XML Schema listed in Document References for a complete list of fields.

Per ACR S.200, customers shall be able to receive syntactically valid maximum and minimum populated messages. Optional data elements (and values therein) shall not cause message failure.

Surescripts may add relevant clinical or non-clinical information within existing message elements to support informed prescribing and enhance provider decision-making.

Element	Code	Comment
Response	mandatory
Processed	mandatory	Processed should only be sent in instances where benefit information is provided. Please reach out to your Surescripts representative for additional information.
Note	conditional	Recommended to send if needed to aid in message processing.
NotProcessed	mandatory
Note	conditional	Additional free text information about the RejectCode. Strongly recommended to send to further explain why message was rejected.
ResponseProduct	conditional
Product	mandatory	Contains the information on the requested medication.
DrugDescription	mandatory	The drug name, strength, and form associated with the NDC.
PricingAndCoverages	mandatory	There may be up to 6 PricingAndCoverages returned per ResponseProduct and ResponseAlternativeProduct. PM.204: Coverage restrictions for all <PricingAndCoverages> elements for medication combinations returned (including alternatives). This concession is allowed: An indicator that coverage restriction(s) apply to a specific combination. User action on this indicator presents all coverage restrictions in their entirety.
EstimatedCombined PlanAndPatientSavings	conditional	Provides additional patient and/or health plan savings information that may assist with medication selection.
EstimatedNetPlanCost	conditional	Provides additional health plan cost information that may assist with medication selection.
ResponseAlternativeProduct	conditional	Clinically appropriate alternatives are provided here. This would include information for an alternative medication (if provided) similar to what is supplied in the ResponseProduct element. PM.205: All available appropriate alternatives displayed together. If all alternatives cannot be shown together, this concession is allowed: An indicator that alternative medications are available. User interaction on this indicator presents all alternative medications together.
PricingAndCoverages/ PricingAndCoverage/ CoverageStatusMessage	conditional	Additional free text information about the coverage status. May be used to communicate non-benefit coverage types as well as coverage restrictions.
PricingAndCoverages/ PricingAndCoverage/ DrugStatus Extension	conditional	Additional free text information about the drug. May be used to communicate drug and pricing specifics.